CMS Administrator Seema Verma says the rule strikes a balance between federal oversight and state flexibility.
The Centers for Medicare & Medicaid Services on Monday released the 2020 Medicaid and Children's Health Insurance Program Managed Care final rule.
CMS Administrator Seema Verma said the final rule cuts red tape and lowers federal regulatory barriers, which allows state Medicaid and CHIP agencies to customize managed care programs for the 55 million beneficiaries – including 79% of CHIP children in 32 states – who are enrolled in Medicaid managed care programs.
"The era of prescriptive regulations has failed. This rule represents a concerted effort to transform Medicaid to improve quality and access for its beneficiaries," Verma said.
Verma said a working group of stakeholders, including the National Association of Medicaid Directors, helped to craft the final rule, which removes some of provisions in the 2016 final rule that stakeholders had complained were overly prescriptive and burdensome.
"This will remove the burden on states while ensuring appropriate oversight of managed care organizations," she said. "The government should identify expected outcomes, results, and standards – not micromanage processes."
Under the final rule, CMS will provide guidelines for states to complete the federal rate review process, while preserving the requirement for states to implement a Quality Rating System for the managed care plans they contract with, CMS said.
The rule also bolsters efforts to provide access and quality care to rural beneficiaries by changing the minimum standards for network adequacy to support state adoption of telehealth.
Most of the provisions take effect 30 days after the Final Rule is issued Nov. 13.
“The era of prescriptive regulations has failed. This rule represents a concerted effort to transform Medicaid to improve quality and access for its beneficiaries.”
CMS Administrator Seema Verma
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
A working group of stakeholders helped to craft the final rule, which removes some of provisions in the 2016 final rule that stakeholders had complained were overly prescriptive and burdensome.
CMS will provide guidelines for states to complete the federal rate review process, while preserving the requirement for states to implement a Quality Rating System for the managed care plans they contract with.
The rule also bolsters efforts to provide access and quality care to rural beneficiaries by changing the minimum standards for network adequacy to support state adoption of telehealth.